Table Of ContentClinical Psychology
for Trainees
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Clinical Psychology
for Trainees
Foundations of Science-Informed Practice
Andrew C. Page
UniversityofWesternAustralia,Perth
Werner G. K. Stritzke
UniversityofWesternAustralia,Perth
Peter M. McEvoy
CurtinUniversity,Perth
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Informationonthistitle:www.cambridge.org/9781108457101
DOI:10.1017/9781108611350
©AndrewC.Page,WernerG.K.StritzkeandPeterM.McEvoy2022
Thispublicationisincopyright.Subjecttostatutoryexception
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permissionofCambridgeUniversityPress.
Firstpublished2006
Secondedition2015
ThirdEdition2022
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary.
LibraryofCongressCataloging-in-PublicationData
Names:Page,AndrewC.(AndrewCharles),1964–author.|
Stritzke,WernerG.K.,1956–author.|McEvoy,PeterM.,author.
Title:Clinicalpsychologyfortrainees:foundationsofscience-informedpractice/
AndrewC.Page,UniversityofWesternAustralia,Perth,WernerG.K.Stritzke,
UniversityofWesternAustralia,Perth,
PeterM.McEvoy,CurtinUniversity,Perth.
Description:Thirdedition.|Cambridge,UnitedKingdom;NewYork,NY:
CambridgeUniversityPress,2022.|Includesbibliographical
referencesandindex.
Identifiers:LCCN2021054775(print)|LCCN2021054776(ebook)|
ISBN9781108457101(paperback)|ISBN9781108611350(epub)
Subjects:LCSH:Clinicalpsychology.|Clinicalpsychologists–Trainingof.|
BISAC:PSYCHOLOGY/MentalHealth
Classification:LCCRC467.2.P342022(print)|LCCRC467.2(ebook)|
DDC616.89–dc23/eng/20211227
LCrecordavailableathttps://lccn.loc.gov/2021054775
LCebookrecordavailableathttps://lccn.loc.gov/2021054776
ISBN978-1-108-45710-1Paperback
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Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-date
informationthatisinaccordwithacceptedstandardsandpracticeatthetimeof
publication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthas
beenmadetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,the
authors,editors,andpublisherscanmakenowarrantiesthattheinformationcon-
tainedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsare
constantlychangingthroughresearchandregulation.Theauthors,editors,and
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fromtheuseofmaterialcontainedinthisbook.Readersarestronglyadvisedtopay
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Contents
1 AScience-InformedModelofClinical 13 Managing Ruptures in
Psychology Practice 1 Therapeutic Alliance 217
2 Relatingwith Clients 12 14 Respecting the Humanity of
Clients: Cross-Cultural and Ethical
3 Assessing Clients 26
Aspectsof Practice 245
4 Matching Treatments and
15 Providing Therapy ata Distance
Monitoring Client Progress 49
and Working in Rural and
5 Linking Assessment to Treatment: Remote Settings 260
Case Formulation 63
16 Psychologists as
6 TreatingClients 96 Health CareProviders 271
7 Brief Interventions 128 17 Workingin Private Practice-
DrClair Lawson; Clinical
8 Low Intensity
Psychologist and Director;
Psychological Interventions 149 Lawson Clinical Psychology 286
9 Group Treatment 157
10 Programme Evaluation 168
11 Case Management 178 References 299
12 Supervision 200 Index 343
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v
Chapter A Science-Informed Model
1
of Clinical Psychology Practice
There has never been a better time to train as a clinical psychologist for three reasons.
First, there is an increasing response to the recognition of the unmet need in mental
health which is resulting in an increase in the number of clinical psychology jobs.
Second, clinical psychology is enjoying a privileged position in mental health care
because of its ability to provide an evidence-base for the services it offers (Newnham &
Page, 2010). Thus, despite the expense incurred by the provision of psychological
services, we can show that their effectiveness assures savings that offset those costs.
Third, the pandemic associated with COVID-19 has put the spotlight on evidence-
based decision-making in health-care. It has been possible to model the impact of
various public health interventions and some nations and states have used this to
guide decision-making to good effect. Some areas have made decisions based on
criteria other than the health evidence and the impact on health at the state and
national level has been evident. In addition to the impacts of the disease itself, the
pandemic has drawn attention to many existing unmet needs in the area of mental
health (Marques et al., 2020) and ongoing, technology-driven changes have been
accelerated in therapy delivery modalities and legal and reimbursement codes for
therapy at a distance. The pandemic has also pointed to the need for a flexible and
responsiveattitudetothedata.Forexample,someoftheearlydirepredictionsofthe
impact of COVID-19 on suicide have not been supported (Pirkis et al., 2021), and
reminded many that we neglected older data showing that national crises can be
protective against suicide, arguably due to improved social cohesion (Botchway & Fazel,
2021)).Thisistheexcitingchallengefacingthegraduatesoftoday’sprogrammes:howwill
youshapeclinicalpsychology?
Consideringthefirstofthesepoints,governmentsacrosstheworldareacknowledg-
ing the need to deal effectively with mental health. Within the United Kingdom, the
response has been the development of an Improving Access to the Psychological
Therapies(IAPT)(NHS,2021)programme.Thisinitiativeaimstodeliverinterventions
for people with depression and anxiety disorders that have been approved by the
National Institute of Health and Clinical Excellence (NICE). In the United States, the
AffordableCareAct(ACA)aimstoimproveequitableaccesstoanimprovedqualityof
mental health care. In Australia, the Better Outcomes in Mental Health Care
(Department of Health, 2021) programme improves community access to quality pri-
mary mental health care by providing access to allied psychological services which
enables general medical practitioners to refer consumers to allied health professionals
who deliver focused psychological strategies. Thus, the desire being expressed inter-
nationally (and tailored to the specific contexts of each nation) is to increase access to
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1
2 Chapter1:AScience-InformedModelofClinicalPsychologyPractice
mentalhealthservices.Thisdesireisleadingtoanincreasingdemandformentalhealth
professionals who are able to provide the treatments required.
Second, there is a common theme across the international initiatives to increase the
quantity of mental health care; namely a focus on quality. Funding agencies want to
ensure that they receive value for money. Consequently, funding is often limited to
treatments that have a strong evidence base. Private and public funders are looking to
allocatescarcehealthcareresourcestoareaswherethereisanassurancethattreatmentis
effective and efficient (McHugh & Barlow, 2010). The profession of clinical psychology
has enjoyed a privileged position as a result of these pressures because it has a long
history of accountability (Lilienfeld, Ammirati & David, 2012). Its professionals are
trained in the critical skills required to evaluate evidence and research methods to
generate data on both existing and new treatments (Pachana et al., 2011). The status
afforded to clinical psychologists, by virtue of their long history in demonstrating the
accountabilityoftheirtreatments,hasmeantthattheprofessionasawholebenefitsfrom
theresearchbasedocumentingtheefficacy,effectivenessandefficiencyofpsychological
treatments (Barlow, 2010;McHugh &Barlow,2010).
Weareatajuncturewhenclinicalpsychologywillcarveoutapaththatwillaffectthe
professionasitgoesforward(Barkham,Hardy&Mellor-Clark,2010;Castelnuovoetal.,
2020; Gruber et al., 2020). The decision facing the profession is: will science-informed
practice inform the future practice of clinical psychology? The perception that psych-
ologyisscientificisnotuniversal(Lilienfeld,2012).Thus,willsciencecontinuetoinform
thefuturepracticeofclinicalpsychology(seeLilienfeld&Basterfield,2020;Safranetal.,
2011; Stewart, Chambless & Baron, 2012)? To contextualize this decision, we will now
discuss arevision of the psychiatricclassificationsystem.
Allen Frances chaired the committee responsible for the fourth revision of the
American Psychiatric Association’s diagnostic system; the Diagnostic and Statistical
Manual of the Mental Disorders (DSM-IV). After the publication of the fifth revision
(i.e.,theDSM-5)hewroteabook,SavingNormal(2014),inwhichhecogentlycritiqued
the new taxonomy and the malign forces which he believed to be responsible for the
errors. As a psychiatrist writing from retirement, he was excluded from any decision-
making,butthereisanotherlevelonwhichthebookcanberead.Muchofhisinvective
is directed at the multinational pharmaceutical companies who, in his opinion, control
the agenda and directly and indirectly influence the formation of diagnostic categories
and the uses to which they are put. However, what is clear is that Frances has seen
(perhapstoolate)thepredicamentthatpsychiatryhasfounditselfin.Inrecentyears,the
number of prescriptions for medications used to treat mental health conditions has
increased to meet the rising demand. Since the number of psychiatrists has remained
relatively static, general practitioners have taken over the role of key provider of
psychopharmacology. Psychiatrists have been relegated to the position of small players
in a big market and their voice, once pre-eminent, has become one among many. For
example, the head of the Royal Australian and New Zealand College of Psychiatrists
echoed the same sentiment in an interview (ABC, 2014) where he noted that some
groups in the community were increasingly more likely to seek advice from their GP
rather than a psychiatrist. Thus, psychiatry is realizing that its pre-eminent position in
mental health care has been eroded. As society has realized that the burden of mental
health care is far larger than psychiatry can ever manage, it has sat by while other
professionshavestepped up tothe task.
Chapter1:AScience-InformedModelofClinicalPsychologyPractice 3
This cautionary tale provides clinical psychology with a window of opportunity. In
thecomingyearstheprofessionofclinicalpsychologywillbesettlingitselfdownintothe
newmentalhealthcareenvironment.Clearlytherearenotenoughclinicalpsychologists
tomeetthementalhealthcareneedsofthetwenty-firstcentury;clearly,therewillnever
be enough (Kazdin, 2011). The appropriately stringent and lengthy training of the
profession will always be a limiting factor. Therefore, the exciting challenge for clinical
psychologists is how to adapt themselves to this new environment. If the profession
continues in the way it has been operating, it risks losing its pre-eminent role, just as
psychiatryhas.Theremainderofthebookwilloutlineonepossiblefuture,wherewewill
argue that clinical psychology must be a science-informed practice. By continuing to
develop, evaluate and offer evidence-based treatments; by delivering treatments in a
monitored error-correcting clinical practice (Lillienfeld & Basterfield, 2020; Scott &
Lewis,2015);bytrainingothermentalhealthprofessionalsinevidence-basedtreatments;
andbyfosteringskillsthatcomplement(ratherthanduplicate)thoseofourcolleaguesin
otherprofessions,clinicalpsychologistswillbringtothementalhealthteamanexpertise
that will ensure them a continuing strong future (Barlow, 2010; Ward et al., 2018;
Youngstrom etal., 2017).
These are both exciting and challenging times and the profession of clinical psych-
ology has a bright future ahead. We are confident because psychologists know that the
best predictor of future behavior is past behavior. If we consider the history of clinical
psychology, we can see that a science-informed approach to practice has served the
profession well. Last century, Hans Eysenck (1952) threw down the gauntlet to clinical
psychologistswhenhereviewedthe24availablestudiesandconcludedprovocativelythat
individuals in psychotherapy were no more likely to improve than those who did not
receivetreatment.Althoughtheconclusionitselfwasquestionablegiventheextantdata
(Lambert, 1976), the field responded assertively and effectively to these criticisms (e.g.,
Meltzoff & Kornreich, 1970). Perhaps the most effective response came from Smith,
Glass,andMiller(1980).Usingmeta-analyticstatisticaltechniquestoreview475studies,
they provided quantitative support for the conclusion that psychotherapy was superior
tobothno-treatmentandplacebocontrolconditions(seealsoAndrews&Harvey,1981;
Prioleau, Murdock & Brody, 1983). More recently, reviewers in the USA, the UK and
Australiahavesoughttotakethenextstepandidentifycriteriaforempiricallysupported
treatments, thereby providing listings of treatments that are “effective” for particular
disorders (e.g., Andrews et al., 1999; Chambless & Hollon, 1998; Nathan & Gorman,
2015; Roth & Fonagy, 2004; Task Force on Promotion and Dissemination of
Psychological Procedures, 1995). In parallel, other reviewers have collated evidence
regarding the effective components of psychotherapy relationships (e.g., Norcross &
Lambert, 2019; Norcross & Wampold, 2019; Orlinsky, Grawe & Parks, 1994; Orlinsky,
Rønnestad & Willutzki, 2004). Together, these two lines of research provide a strong
responsetoEysenck’scriticism.Whilepeoplecontinuetodebatetherelativemeritsand
contributionsofthepsychotherapyrelationshipandthespecificsofparticulartherapies
(e.g., Asnaani & Foa, 2014; Laska, Gurman & Wampold, 2014; Norcross & Lambert,
2019;Norcross&Wampold,2011;Wampold,2001),theconclusionthatpsychotherapy
is better than no treatment, and better than a supportive caring relationship alone, is
strongly supported.
Thus, Eysenck’s provocative comments spurred a spirited and methodical response
that allowed clinical psycholohgtytpst:o//avcxlehamrl.sye/dbelofgesn/dhilli0tself against general criticisms of
